In this elaborate review article, the authors have described various aspects of laryngomalacia and its surgical management with supraglottoplasty or otherwise, gleaned from an extensive review of the literature which provided evidence or the lack of it in relation to various concepts and practices in the management of this condition. The authors observed that the literature lacks stratification or correlation of clinical presentation. The epiglottis may show posterolateral inversion, anterior inversion or complete collapse but most individuals show mixed patterns. Flexible endoscopy under sedation or anaesthesia has better sensitivity and specificity in establishing a diagnosis. Obstructive sleep apnoea is associated with laryngomalacia, especially if there are neuorological conditions and prematurity. Supraglottoplasty reduces this obstruction. Gastro-oesophageal reflux with swallowing dysfunction is a frequent accompaniment of laryngomalacia and is commoner if there are other airway lesions such as tracheo-oesophageal fistula. It was noted that there is a lack of detailed description of surgical measures. Outcomes are adversely affected by associated comorbidities and prematurity, this being the highest risk factor. Staging supraglottoplasty and doing the other side later, only if required, is generally accepted to avoid complications such as stenosis and aspiration. The need for additional procedures such as tonsillectomy and tracheostomy or even gastrostomy has been reported in children with Down’s syndrome. It is noted that successful surgical outcomes in uncomplicated laryngomalacia could have also been helped by natural recovery.

Laryngomalacia: is there an evidence base for management?
McCafer C, Blackmore K, Flood LM.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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